贝克认知疗法对乳腺癌患者心理状态及睡眠质量的影响

目的改善乳腺癌患者负性情绪及睡眠障碍。方法将84例乳腺癌手术治疗患者,按时间段分为对照组和观察组各42例,两组均予常规治疗与护理,在此基础上对照组给予常规心理护理,观察组采用贝克认知疗法干预。连续干预至出院前评价效果。结果干预后观察组焦虑、抑郁评分及睡眠质量评分显著低于对照组(均P0.05)。结论贝克认知疗法干预可有效降低乳腺癌患者焦虑、抑郁情绪,从而改善患者睡眠质量。     

表柔比星配合多西他赛新辅助化疗对乳腺癌患者近远期疗效及细胞核增殖抗原表达的影响

目的:探讨表柔比星配合多西他赛新辅助化疗对乳腺癌患者近远期疗效及细胞核增殖抗原(Ki-67)表达的影响。方法:选取2017年1月至2018年2月山西白求恩医院乳腺外科收治的81例乳腺癌患者,以随机数字表法分为两组,对照组采用常规化疗方案为环磷酰胺+表柔比星+氟尿嘧啶,观察组给予新辅助化疗方案为环磷酰胺+表柔比星+多西他...     

多学科团队协作对乳腺癌患者深静脉血栓防治的效果

目的 探讨多学科团队协作模式在乳腺癌患者深静脉血栓防治中的应用效果.方法 采取前瞻性非同期类实验设计,按照入院时间将412例乳腺癌患者分为对照组与观察组各206例.对照组采用常规血栓预防方案;干预组采用多学科团队协作模式,按照团队制订的血栓预防流程及分层预防方案,落实乳腺癌围术期患者血栓防控工作.结果 干预组血栓及出血...     

乳腺癌改良根治术患者的护患互动式综合干预

目的探讨护患互动式综合干预用于乳腺癌改良根治术患者的效果。方法将170例拟行乳腺癌改良根治术患者按不同病区分为干预组和对照组各85例。干预组给予护患互动式综合干预,包括互动资料收集、互动方案初建、实施互动循环和互动效果反馈4个环节,推动患者/家属主动参与治疗护理活动;对照组给予常规护理。干预3个月评价效果。结果干预组患肢前屈、外展角度及握力显著高于对照组(P0.05,P0.01)。结论护患互动式综合干预促使患者积极参与治疗护理,可有效促进患肢功能恢复。     

烧伤植皮联合综合性康复护理干预治疗手部烧伤临床效果分析

目的:分析烧伤植皮联合综合性康复护理干预对手部烧伤患者的治疗效果.方法:2017年1月-2020年2月于笔者医院烧伤科收治的122例手部烧伤患者随机分为对照组和观察组,各61例.两组均采用烧伤植皮手术进行治疗,对照组术后住院期间采用常规护理干预,观察组在对照组的基础上采用综合性康复护理干预,术后随访3个月.比较两组术前...     

心理干预在乳腺癌围手术期患者的应用效果观察

目的探讨实施心理干预在乳腺癌围手术期患者应用疗效。方法将60例乳腺癌患者随机分为观察组和对照组各30例,对照组予乳腺癌围术期常规护理,观察组在常规护理基础上采用心理护理措施,应用焦虑自评量表(SAS)和抑郁自评量表(SPS),对两组患者在心理干预前后进行测量。结果两组患者在心理干预后前进行测量观察组患者焦虑程度明显低于对照组,两组相比,差异有统计学意义(P0.05)。结论对乳腺癌患者实施围术期心理护理干预,可提高患者治疗依从性和降低焦虑症的发生率,有效改善预后。     

护理干预对普外术后患者疼痛的影响

目的:探讨护理干预对普外术后患者疼痛的影响.方法:将320例胃肠道,食道及乳腺癌手术后患者随机分为干预组和对照组,对照组进行常规镇痛治疗和护理,干预组进行综合护理干预.结果:干预组患者术后镇痛效果优于对照组,其差异有统计学意义(P<0.01),各护理干预措施与疼痛控制情况之间呈显著正相关(P<0.01).结论;综合护理干预可提高术后镇痛治疗效果,有效缓解患者术后疼痛.     

人性化护理措施对提高乳腺癌患者术后生活质量的疗效观察

目的探讨人性化护理干预对乳腺癌患者术后生活质量的效果。方法将80例乳腺癌术后患者随机分为2组,各40例。对照组给予常规护理,观察组常规护理基础上实施心理、健康教育等人性化护理干预。依据乳腺癌患者生活质量评定表对2组进行比较分析。结果观察组患者的身体、心理、角色功能等生活质量指标明显优于对照组,比较差异有统计学意义(P0.05)。结论人性化护理干预可有效缓解乳腺癌患者心理及生理压力,增强患者的治疗依从性,改善护理质量和预后。     

心理护理干预对乳腺癌化疗效果的影响

目的探讨心理护理对乳腺癌化疗患者治疗效果的影响。方法将100例乳腺癌化疗患者(化疗次数≥2次)随机分为对照组和干预组,各50例。对照组化疗期间行常规护理。干预组在常规护理基础上实施心理护理。比较2组护理后生活质量、评定情况。结果干预组患者生活质量中部分功能(躯体功能、角色功能、情绪功能、疲乏、恶心呕吐、失眠)改善明显优于对照组。2组比较,差异有统计学意义(P<0.05)。结论乳腺癌化疗患者存在不同程度心理障碍,实施心理护理干预,可有效缓解或消除焦虑等不良情绪,提高患者治疗信心,改善患者生活质量。     

宣泄和认知行为干预对乳腺癌术后化疗患者焦虑抑郁的影响

目的探讨宣泄疗法和认知行为干预对乳腺癌术后化疗患者焦虑和抑郁的影响。方法选择2006年9月至2009年3月的97例乳腺癌术后化疗患者,分成试验组(47例)和对照组(50例),试验组在常规护理的基础上结合以宣泄、认知教育、放松训练为主的综合性护理干预措施,对照组仅⒚常规护理。护理干预前后分别采⒚Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)测评患者的焦虑和抑郁情绪,比较两组患者焦虑和抑郁情绪的变化。结果试验组护理干预后较干预前焦虑和抑Ⅳ情绪有明显改善(P0.01)。结论VEGF在晚期胃癌组织中表达与治疗后的生存期有关,可能影响治疗方案的选择。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.